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Letters to the Editor  |   December 2009
Cranial Palpation Pressures Used by Osteopathy Students
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Neuromusculoskeletal Disorders
Letters to the Editor   |   December 2009
Cranial Palpation Pressures Used by Osteopathy Students
The Journal of the American Osteopathic Association, December 2009, Vol. 109, 655-656. doi:10.7556/jaoa.2009.109.12.655
The Journal of the American Osteopathic Association, December 2009, Vol. 109, 655-656. doi:10.7556/jaoa.2009.109.12.655
To the Editor:  
Rafael Zegarra-Parodi, DO (England), and colleagues are right on the mark regarding their July response1 to the four letters2-5 criticizing their February original contribution,6 which reported measurements of the effects of standardized protocol training on palpation pressures used by osteopathy students in France. 
For more than 20 years, I have been hearing from members of the osteopathic medical profession that it is more important to feel then to measure. During this same time, however, the osteopathic medical profession has been “selling off” its osteopathic manipulative medicine (OMM) techniques to other professions through courses given to physical therapists and through training provided at The Upledger Institute in Palm Beach Gardens, Florida. Thus, although the critics2-5 of Zegarra-Parodi et al6 expressed concern about the use of manual techniques of osteopathic origin within nonosteopathic professions, it is time for the osteopathic medical profession to recognize that this “cat is already out of the bag.” 
In their medical education article in the July issue, Benjamin R. Bates, PhD, and colleagues7 highlighted related aspects of the osteopathic medical profession's difficulties. Reporting results of a survey of osteopathic medical students, they concluded that “[i]mproved student awareness of OPP [osteopathic principles and practice] is essential to maintaining the DO difference in clinical practice and with regard to the DO degree designation.” 
One of the solutions to all of these problems is to finally push forth a new frontier of scientific research into the physiologic processes behind OMM. There are surely enough talented and brilliant individuals in the osteopathic medical profession to make this happen. 
Controversy regarding the physiologic processes that occur in patients undergoing osteopathy in the cranial field has been ongoing for many years.8 However, even when scientific facts on this matter are presented, some members of the osteopathic medical profession tend to dismiss them. One principle example of this tendency concerns the sphenobasilar synchondrosis. Although scientists have known for many years that the sphenobasilar synchondrosis fuses by adulthood,9,10 some practitioners in the osteopathic medical profession continue to profess that there is flexion and extension at this fused juncture,11,12 as first taught by William Garner Sutherland, DO.13,14 The idea seems to be, “we can feel it, therefore it is.” 
Evidence-based research could investigate the physiologic nature of osteopathy in the cranial field and resolve the controversy once and for all. If the evidence clearly proves that a unique, reproducible craniosacral rhythm exists, such a finding would herald a golden age for osteopathic medicine. If in the end, however, the evidence shows that no unique, reproducible craniosacral rhythm exists, then a new direction for determining causes of observed clinical responses in osteopathy in the cranial field needs to be pursued. 
There is certainly “something” that is occurring therapeutically in patients who are treated with our OMM techniques, and it is time to push forward and determine what it is. I congratulate Zegarra-Parodi et al1,6 for their attempts at conducting such research in the realm of cranial manipulation. The last substantial research into the physiologic basis of OMM was conducted by Irvin M. Korr, PhD.15 We now have the technology to begin a new era in this type of research. Imagine if you could actually understand how Fulford's percussion vibrator technique works, or if it really is this technique that is causing observed responses in patients. The clinical possibilities resulting from such knowledge are endless. 
Osteopathic manipulative medicine techniques have taken us as far as they can based on palpation alone, and it is now time to move forward with measurable evidence-based research. Who knows how far such research could take us? 
Zegarra-Parodi R, de Chauvigny de Blot P, Renard E-O, Rickards LD. Response [letter]. J Am Osteopath Assoc. 2009;109:381-382. http://www.jaoa.org/cgi/content/full/109/7/381. Accessed September 25, 2009.
Kary D. Cranial palpation pressures used by osteopathy students [letter]. J Am Osteopath Assoc. 2009;109:378-379. http://www.jaoa.org/cgi/content/full/109/7/378. Accessed September 25, 2009.
Abu-Sbaih R. Cranial palpation pressures used by osteopathy students [letter]. J Am Osteopath Assoc. 2009;109:379. http://www.jaoa.org/cgi/content/full/109/7/379. Accessed September 25, 2009.
Zubcevik N. Cranial palpation pressures used by osteopathy students [letter]. J Am Osteopath Assoc. 2009;109:379-380. http://www.jaoa.org/cgi/content/full/109/7/379. Accessed September 25, 2009.
Rosen ME. Cranial palpation pressures used by osteopathy students [letter]. J Am Osteopath Assoc. 2009;109:380-381. http://www.jaoa.org/cgi/content/full/109/7/380. Accessed September 25, 2009.
Zegarra-Parodi R, de Chauvigny de Blot P, Rickards LD, Renard E-O. Cranial palpation pressures used by osteopathy students: effects of standardized protocol training. J Am Osteopath Assoc. 2009;109:79-85. http://www.jaoa.org/cgi/content/full/109/2/79. Accessed September 25, 2009.
Bates BR, Mazer JP, Ledbetter AM, Norander S. The DO difference: an analysis of causal relationships affecting the degree-change debate. J Am Osteopath Assoc. 2009;109:359-369. http://www.jaoa.org/cgi/content/full/109/7/359. Accessed September 25, 2009.
Chaitow L. Cranial Manipulation Theory and Practice: Osseous and Soft Tissue Approaches. New York, NY: Churchill Livingstone; 1999: 82-91.
Strandring S, ed. Gray's Anatomy: The Anatomical Basis of Clinical Practice. 40th ed. New York, NY: Churchill Livingstone; 2008.
Nakahara K, Utsuki S, Shimizu S, Iida H, Miyasaka Y, Takagi H, et al. Age dependence of fusion of primary occipital sutures: a radiographic study [published online ahead of print September 2, 2006]. Childs Nerv Syst. 2006;22:1457-1459.
Timoshkin EM, Sandhouse M. Retrospective study of cranial strain pattern prevalence in a healthy population. J Am Osteopath Assoc. 2008;108:652-656. http://www.jaoa.org/cgi/content/full/108/11/652. Accessed September 25, 2009.
Caban-Martinez A, Timoshkin E, Sandhouse ME, Shechtman D, Fecho G, Snyder A, et al. The effect of cranial osteopathic treatment on visual function [abstract]. J Am Osteopath Assoc. 2007;107:327-364. P5. http://www.jaoa.org/cgi/content/full/107/8/327. Accessed September 25, 2009.
Sutherland WG. The cranial bowl [reprint of 1948 article]. J Am Osteopath Assoc. 2000;100:568-573. http://www.jaoa.org/cgi/reprint/100/9/568. Accessed September 25, 2009.
Sutherland WG, Magoun HI. Osteopathy in the Cranial Field. Kirksville, MO: Journal Printing Co;1966 .
Korr IM, Buzzell KA, Hix EL, Northup GW; Kugelmass IN, ed. The Physiological Basis of Osteopathic Medicine. New York, NY: Postgraduate Institute of Osteopathic Medicine and Surgery;1982 .♦